How Will the 'End of Life Option' Affect Your Practice?

What mental health clinicians need to know about ABX2 15

Beginning June 9, 2016, California's terminally ill residents will have more control over how they choose to live their final moments. The End of Life Option Act—ABX2 15, California's version of Oregon's Death With Dignity law—goes into effect following a 25-year effort to pass similar laws. It wasn't until October 2015 that California Governor Jerry Brown signed the latest version of the bill into law. The aid-in-dying law passed almost one year after former California resident Brittany Maynard's medication-assisted death in Oregon brought international attention to the need for a choice in how one lives and dies with a terminal illness.

"One of the biggest changes with this law will be the legitimization of the discussions that are already happening in many mental health situations," says Jull-Patterson. "The patient who brings this topic up is saying, ‘I'm not happy with what's going on, and I want to change it.’ To me, that's an invitation to begin a conversation that may end up more focused on suffering, loneliness, pain control, depression or loss of meaning. In all of those areas, mental health professionals can have a great impact, whether it is working with the individual patient, the family, the community or the larger health care system.

"Too often, however, health care professionals don't have the training to enter into these conversations; consequently, a number of federal studies have emphasized the need for this type of training," he continues. "The new law will direct attention to the needs of those beginning the end-of-life process and be a call for caretakers to provide their patients with support, understanding and compassion during this emotional time."

Did You Know?
More than one-third of those who obtain the medication prescribed under the laws in Oregon and Washington never take it.

According to the bill, to invoke the end-of-life option it must first be determined that "the requesting adult has the capacity to make medical decisions, and if there are indications of a mental disorder, the attending physician shall refer the individual for a mental health specialist assessment” before any drugs are prescribed. The law requires that the mental health specialist be a psychiatrist or psychologist. However, an advocate’s role is also crucial in order for a patient to understand this process and be able to talk about this kind of decision.

Related: Watch our public lecture The End of Life Option Act: Clinical and Legal Implications (via YouTube, Jan. 26, 2017)

Jull-Patterson advises, "It is important to recognize whether or not the patient’s request for a hastened death is actually a plea for increased quality of life. Often when someone is nearing the end of life, the feeling of being overwhelmed may be particularly salient, and one way to address that may seem to be to hasten one's death. While this is a viable option, I would suggest first looking at the requestor's quality of life. An underlying force in end-of-life conversations is finding the meaning of life, in whatever form that might take."

But end-of-life counseling needs to go beyond having a spiritual discussion. In order to provide legal, ethical and clinically sound health care services to patients, families and communities, health advocates and clinicians need to be well-informed of their place in the process. In Jull-Patterson's workshop, you learn how to:

compare and contrast professional ethical standards, principles and policies to inform clinical decisions about aid in dying

classify the role of a mental health clinician with patients and their families who are considering aid in dying

articulate your own feelings and attitudes about patients making aid-in-dying decisions

"Our job is to provide the best care we can to our patients, their families and their communities," says Jull-Patterson. "In order to do that, we have to be fluent in the current clinical standards of practice and understand the legal and ethical underpinnings of these profoundly intimate conversations at the end of life."

David Jull-Patterson, Ph.D., FT, Extension Honored Instructor, maintains an independent practice in clinical health psychology with a focus on life-threatening illness and palliative care. He is a member of the California Psychological Association's ethics committee and an award-winning clinical professor teaching medical students at UCSF. He also teaches Clinical and Ethical Approaches to End-of-Life Care.

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